Disadvantaged pre-schoolers attending day care in Salvador, Northeast Brazil have a low prevalence of anaemia and micronutrient deficiencies

Abstract

Objective: To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections. Design: In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B 12 , retinol, Zn and Se. Setting: Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil. Subjects: Pre-schoolers aged 3-6 years from disadvantaged households. Results: Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were #5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P , 0?05) of Hb were a 3?7 thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P , 0?05) were: elevated a 1 -glycoprotein for ferritin, Hb AS and BMI Z-score .1 for transferrin receptor, Zn and elevated a 1 -glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B 12 , and Giardia intestinalis infection for serum folate. Conclusions: Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.

Zinc deficiency and its predictive capacity for anemia: Unique model in school children

“…Lander et al noted a modest association between serum zinc and anemia in preschool children. 20 They studied serum selenium, ferritin, transferrin receptor, folate, VB12 and a-thalassemia, and found that serum selenium, retinol and hemoglobinopathy predicted Hb level, but that iron status markers such as ferritin and transferrin receptor did not. In contrast, the present case-control study assessed Asian children with age and racial differences, and analyzed the differences in zinc level according to anemia status.…”

Understanding the complex determinants of height and adiposity in disadvantaged daycare preschoolers in Salvador, NE Brazil through structural equation modelling

“…Details of the recruitment of the preschoolers, their socio-demographic, anthropometric, micronutrient, and infection status have been reported earlier [ 16 , 17 ]. Briefly, a cross-sectional study of 376 disadvantaged preschoolers aged between 3 and 6 years was conducted in seven philanthropic daycare centers located in Salvador, the capital city of Bahia, NE Brazil from August – November, 2010.…”

“…A faecal concentrate was examined by microscopy for the presence of helminths and hookworm, whereas data on the treatment for de-worming in the last 6 months was obtained by mother or caregiver report via questionnaire [ 16 ]. Morning fasting veni-puncture blood samples were drawn for analyses of haemoglobin (Hb), serum zinc and selenium, as described in detail earlier [ 17 ]. Briefly, serum zinc was analyzed by flame atomic absorption spectrophotometry (ContrAA 700, Analytik Jena, Germany) and serum selenium by electrothermal atomic absorption spectrophotometry (AA-800, Perkin Elmer 2690, Ebos Group Ltd, Auckland, New Zealand).…”

“…The between-assay coefficients of variation (CV as %) for serum zinc and selenium were 5 and 7 %, respectively and the values for the certified reference materials fell within the certified ranges. Anaemia was defined as Hb < 110 g/L and < 115 g/L for children < 5 years and ≥ 5 years, respectively, and low zinc and selenium status as serum zinc < 9.9 μmol/L and serum selenium ≤ 0.82 μmol/L, respectively [ 17 ].…”

“…Both direct and indirect relationships between socio-economic, biological, environmental, and micronutrient variables on height and adiposity, as reflected by Z-scores for height-for-age (HAZ) and body mass index (BMIZ), were examined. Variables chosen were known or hypothesized to influence HAZ and BMIZ-scores of the preschoolers based on our earlier cross-sectional findings [ 16 , 17 ] and theoretical evidence from the literature. It was expected that use of the SEM would broaden our understanding of the complex inter-relationships among any modifiable variables associated with height and adiposity, and thus help in designing tailored and potentially more effective interventions for disadvantaged preschoolers in similar settings.…”